ART Monitoring & ADR Substitution Guide

Adverse Drug Reaction Management & Single-Drug Switch Pathway · v1.7
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How to use this tool: Enter the current regimen and the adverse effect. The tool identifies the drug responsible and returns a substitution. Substitute the single offending drug rather than switching the whole regimen, which is reserved for virological failure.
1. Current Regimen
2. Identified Adverse Drug Reaction
3. Relevant Parameters
NACO Monitoring Schedule by Regimen
Investigation TDF-based AZT-based All Regimens
Serum Creatinine / CrCl Baseline, 3 months, then 6-monthly Baseline As indicated
CBC with Differential Baseline Baseline, 4 weeks, 3 months, then 6-monthly As indicated
HIV Viral Load 6 months, then annually 6 months, then annually Primary measure of treatment success
CD4 Count Baseline, 6 months Baseline, 6 months Discontinue once stable > 200 on suppressive ART
ALT / AST Baseline, as indicated Baseline, as indicated More frequent if NVP-based or HBV coinfection
Fasting Glucose / Lipids Baseline, annually Baseline, annually DTG: monitor for metabolic syndrome
Urine Dipstick Baseline, 6-monthly (glycosuria, proteinuria) Baseline Screen for TDF tubular toxicity
Pregnancy Test As indicated As indicated All women of childbearing age at each visit
1. ADR Recognition Quick Reference
DrugKey ADRTime to OnsetAction
TDFNephrotoxicity, Fanconi syndrome3 to 12 monthsSwitch TDF to AZT or ABC
AZTAnaemia, neutropenia4 to 12 weeksSwitch AZT to TDF or ABC
AZTMyopathy, lipoatrophy6 to 18 monthsSwitch AZT to TDF
ABCHypersensitivity ReactionFirst 6 weeksStop immediately. NEVER rechallenge.
DTGNeuropsychiatric, weight gainWeeks to monthsSwitch to EFV (if tolerated) or ATV/r
EFVCNS toxicity, gynaecomastiaFirst 2 to 4 weeksSwitch EFV to DTG
NVPHepatotoxicity, SJSFirst 6 to 18 weeksStop immediately. Switch to DTG.
Abbreviations: ABC (Abacavir) · ADR (Adverse Drug Reaction) · ALT (Alanine Aminotransferase) · ANC (Absolute Neutrophil Count) · ART (Antiretroviral Therapy) · AST (Aspartate Aminotransferase) · ATV/r (Atazanavir/Ritonavir) · AZT (Zidovudine) · BD (Twice Daily) · CBC (Complete Blood Count) · CD4 (Cluster of Differentiation 4) · CNS (Central Nervous System) · CPK (Creatine Phosphokinase) · CrCl (Creatinine Clearance) · DTG (Dolutegravir) · EFV (Efavirenz) · FDC (Fixed-Dose Combination) · GI (Gastrointestinal) · Hb (Haemoglobin) · HbA1c (Glycated Haemoglobin) · HBV (Hepatitis B Virus) · HIV (Human Immunodeficiency Virus) · HLA-B*5701 (Human Leucocyte Antigen B, Allele 5701) · HSR (Hypersensitivity Reaction) · IRIS (Immune Reconstitution Inflammatory Syndrome) · LFT (Liver Function Test) · MI (Myocardial Infarction) · NACO (National AIDS Control Organisation) · NNRTI (Non-Nucleoside Reverse Transcriptase Inhibitor) · NVP (Nevirapine) · OD (Once Daily) · OI (Opportunistic Infection) · SBAR (Situation, Background, Assessment, Recommendation) · SJS (Stevens-Johnson Syndrome) · TAF (Tenofovir Alafenamide) · TDF (Tenofovir Disoproxil Fumarate) · TLd (Tenofovir + Lamivudine + Dolutegravir) · TLE (Tenofovir + Lamivudine + Efavirenz) · ULN (Upper Limit of Normal) · VL (Viral Load) · 3TC (Lamivudine)
References
  1. NACO. National Guidelines for HIV Care and Treatment. MoHFW, GoI; 2021.
  2. NACO. National Technical Guidelines on ART. 2018 (Updated 2021).
  3. WHO. Consolidated guidelines on HIV. 2021.
  4. World Health Organization. WHO updated recommendations on HIV clinical management: recommendations for a public health approach. Geneva: WHO; 7 January 2026. [First substantial revision since 2021. DRV/r becomes the preferred boosted PI; supports reuse of TDF and ABC in subsequent regimens; long-acting injectable ART and oral two-drug regimens in defined circumstances; revised vertical transmission and TB preventive treatment guidance. NACO remains the operative source for Indian practice.]
How to Cite This Tool

AMA: Umakanth S. ART Monitoring & ADR Substitution Guide. MEDiscuss. Published 2026. Accessed .

Vancouver: Umakanth S. ART Monitoring & ADR Substitution Guide [Internet]. MEDiscuss.org; 2026 [cited ]. Available from:

Disclaimer and scope
Disclaimer: This decision-support system is intended for healthcare professionals. It does not substitute clinical judgment. These algorithms are evidence-based, but medical knowledge evolves continuously. The treating physician retains absolute responsibility for all diagnostic, dosing, and therapeutic decisions. Always verify outputs against current institutional protocols and individual patient contexts.
© 2026 MEDiscuss.org. All rights reserved. This CDSS Module was designed and developed by Dr. Shashikiran Umakanth using the available evidence base. Provided free of charge for clinical use. Unauthorised reproduction or redistribution is strictly prohibited.
Category Therapeutic & Management PathwaysGuide
Specialties Internal Medicine, Infectious Diseases, HIV Medicine
Written and maintained by Dr Shashikiran Umakanth.
Last revised: 8 August 2026
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